极低出生体重儿胃肠喂养的临床观察

目的　总结极低出生体重儿 (VLBWI)胃肠喂养的临床特点、分析喂养不耐受的相关因素、探讨有利于喂养成熟的要点。方法　对NICU收治的极低出生体重并痊愈出院的 3 8例婴儿进行喂养相关因素和体重增长情况调查。本组患儿出生体重 ( 13 14± 180 )g。按是否有多次出现喂养后呕吐、腹胀、胃残余超过喂入量的 3 0 %、胃内咖啡样物、被禁食 >2次、第 2周末喂入量 <8ml/ (kg·次 )分为喂养不耐受或耐受两组 ,分析喂养不耐受的相关危险因素 ;按早开始 (≤ 6d)和晚开始 (≥ 7d)胃肠喂养分成两组 ,比较有关临床因素。结果　喂养不耐受的发生率为 5 5 % ( 2 1/ 3 8)。喂养耐受和不耐受两组的胎龄、出生体重、开奶日龄、达足量喂养日龄及住院天数差异有显著性。胎龄小、脐插管、应用氨茶碱及开始胃肠喂养日龄晚是喂养不耐受的显著相关危险因素。早开奶组达足量喂养日龄 [( 2 9 0± 11 2 )d]和住院天数 [( 41 7± 12 4)d]较晚开奶组明显缩短 [分别为 ( 41 8± 16 9)d和 ( 5 5 4± 17 5 )d],差异有显著意义。结论　如果VLBWI的生命体征平稳 ,在出生 6d内应尽可能早地开始胃肠道喂养或非营养性吸吮。早期微量喂养、缓慢加奶、谨慎禁食、促进排便 ,有利于促进喂养耐受性     

Minimal enteral nutrition

Although parenteral nutrition has been used widely in the management of sick very low birth weight (VLBW) infants, a smooth transition to the enteral route is most desirable. Animal studies have shown that long periods of starvation are associated with mucosal atrophy and reduction of enzymatic activity. Studies have shown that giving small volumes of feeds frequently exerts a trophic effect on the gut mucosa. This concept has been termed as Minimal Enteral Nutriton (MEN). Clinical benefits of MEN include faster progression to full enteral feeds, lesser episodes of feed intolerance and reduction in hospital stay without a concomitant increase in the risk of necrotizing enterocolitis. MEN may be commenced in neonates on ventilation and total parenteral nutrition. A protocol for giving MEN has been described.     

Predictors of breastfeeding in very low birthweight infants at the time of discharge from hospital.

In a case-control study carried out in the Kuala Lumpur Maternity Hospital between 1st July 1995 and 31st January 1996 the objectives were (1) to determine the rate of breastfeeding in surviving very low birthweight (VLBW, < or = 1500 g) Malaysian infants following the introduction of the Baby Friendly Hospital Concept, and (2) to identify significant predictors associated with successful breastfeeding in these infants. During the study period, 201 (1.24 per cent) of live-born infants were VLBW infants, 192 (95.5 per cent) were Malaysians, and 141 (73.4 per cent) of them survived to go home. The breastfeeding rate among all surviving VLBW Malaysian infants at the time of discharge was 40.2 per cent (57/141). The mothers of 126 (89.4 per cent) VLBW Malaysian infants were interviewed before discharge. Logistic regression analysis showed that, after controlling for various confounders, the significant predictors associated with successful breastfeeding were: (a) Malay mothers (odds ratio: 6.0; 95 per cent CI: 1.9, 19.4), (b) mothers with educational levels of between 7 and 9 years (odds ratio: 3.6; 95 per cent CI: 1.0, 12.2), and (c) earlier age of commencement of enteral feeds in the VLBW infants (for each additional day delay in commencement of feeding, odds ratio of breastfeeding was 0.5; 95 per cent CI: 0.4, 0.8).     

Early feeding advancement in very low-birth-weight infants with intrauterine growth retardation and increased umbilical artery resistance

BACKGROUND: To investigate whether intrauterine growth retardation (birth weight <10th percentile), increased umbilical artery resistance (resistance index >90th percentile measured by Doppler velocimetry), or brain sparing (increased umbilical artery resistance and decreased middle cerebral artery resistance index <5th percentile) were associated with early feeding intolerance in very low-birth-weight (VLBW, <1,500 g) infants. METHODS: From July 1999 to December 2000, 124 inborn VLBW infants were enrolled in a prospective trial evaluating early enteral nutrition after a standardized feeding protocol (daily feeding advancement, 16 mL/kg birth weight). Feeding tolerance was assessed as the age at which full enteral feeds (150 mL/kg daily) were achieved. Data are shown as median, 25th, and 75th percentiles. RESULTS: Full enteral feeds were achieved at 15 days (range, 12-21 days) of age for all infants. Intrauterine growth retardation (full enteral feeding achieved at 14 days; range, 12-21 days), increased umbilical artery resistance (full enteral feeding achieved at 14 days; range, 11-16 days), and brain sparing (full enteral feeding achieved at 15 days; range, 14-20 days) were not associated with early feeding intolerance. CONCLUSION: Very low-birth-weight infants with intrauterine growth retardation, increased umbilical artery resistance, and brain sparing tolerated enteral feeding as well as appropriate-for-gestational-age VLBW infants.     

Stool water loss in very-low-birth-weight neonates

Fluid requirements in very-low-birth-weight (VLBW) infants include compensation for renal, insensible (skin and lung), and stool losses and provision for fluid retained for growth. Current estimates of stool water losses in VLBW infants are based on measurements established in term neonates. Therefore, the water content of 24-hour stool collections were determined in 11 healthy VLBW male infants on full enteral feeds and compared to the working norms. The neonates in this study were less than 2 weeks old with a mean +/- SD birth weight and gestational age of 1,311 +/- 112 g and 30.8 +/- 1.5 weeks, respectively. They were receiving only enteral formula feedings of 100 ml/kg/day or more with no parenteral fluid supplementation. The mean +/- SD number of stools and water content of the stools was 2.7 +/- 2.0/day and 7.2 +/- 4.0 ml/kg/day, respectively. There was a significant correlation (r = 0.696, p less than 0.02) between gestational age at birth and number of stools per day, but the correlation between stool water loss per day, gestational age, volume of feedings per day, and birthweight was not significant. Based on this study, 7 ml/kg/day is a reasonable estimate of daily stool water loss in VLBW babies.     

Effect of enteral administration of insulin on intestinal development and feeding tolerance in preterm infants: a pilot study

OBJECTIVE: To determine in a pilot study whether enteral administration of insulin to preterm infants (26-29 weeks of gestational age) would enhance gastrointestinal development and reduce feed intolerance without adverse effects. DESIGN: Eight preterm infants were given 4 U/kg/day insulin enterally from 4 to 28 days of age. Lactase activity was measured at 28 days of age, while measures of feed intolerance were made throughout the hospital stay. The results were compared with those of a matched historical cohort of 80 preterm infants. SETTING: Tertiary care, university affiliated hospital. Main outcome measures: Lactase activity and feed intolerance. RESULTS: No adverse effects, such as hypoglycaemia, were observed after administration of insulin. The infants who received insulin had higher lactase activity and less feed intolerance than the controls (30% shorter time to full enteral feeds; fewer gastric residuals per infant). CONCLUSION: These preliminary data suggest that enteral insulin administration may be of benefit in reducing feed intolerance in preterm infants. A randomised, blinded trial is warranted.     

Slow versus fast enteral feed advancement in very low birth weight infants: a randomized control trial

OBJECTIVE: To evaluate the tolerance of rapid advancement of enteral feeds in VLBW babies. SETTING: Tertiary teaching hospital. DESIGN: Randomized controlled trial. METHODS: All stable neonates with birth weight less than 1250 grams were included in the study. The primary outcome variable was the time taken to achieve full enteral feeds (defined as 180 ml/kg/day). The secondary outcome variables were incidence of Necrotizing enterocolitis (NNEC) and incidence of apnea. At 48 hours, the infants were randomized into the slow advancement group (enteral feeds advanced by increments of 15 ml/kg/day) or fast advancement group (enteral feeds advanced by increments of 30 ml/kg/day). The monitoring during feeding included daily weight record, two hourly abdominal girth charting, gastric aspirates, apnea, time taken to reach full enteral feedings and for NNEC. RESULTS: There were 53 infants who were enrolled for the study (27 in the fast advancement group and 26 in the slow advancement group). In the fast advancement group, 20 percent completed the trial; whereas 14 (53.8 percent;) in the slow advancement group completed the study. The two groups were comparable for birth weights, gestational age, sex, intrauterine growth status, Apgar and CRIB scores. The infants in the fast group reached full enteral intake of 180 ml/kg/day significantly earlier (10 +/- 1.8 days) than in the slow group (14.8 +/- 1.5 days). The two groups were comparable for episodes of feed intolerance, apnea, NNEC. Infants in the fast group regained birth weight significantly earlier (median 18 days) than in the slow advancement group (median 23 days). CONCLUSIONS: Stable VLBW neonates can tolerate rapid advancements of enteral feeding without increased risk of adverse effects.     

A national study of risk factors associated with mortality in very low birthweight infants in the Malaysian neonatal intensive care units

To determine the risk factors associated with mortality in very low birthweight (VLBW) infants admitted to the neonatal intensive care units (NIUC) in Malaysia.

Method:

A prospective observational study of outcome of all VLBW infants born between 1 January 1993 and 30 June 1993 and admitted to the NICU.

Results:

Data of 868 VLBW neonates from 18 centres in Malaysia were collected. Their mean birthweight was 1223 g (95% confidence intervals: 1208–1238 g). Thirty-seven point four per cent (325/868) of these infants died before discharge. After exclusion of all infants with congenital anomalies ( n =66, and nine of them also had incomplete records) and incomplete records ( n =82), stepwise logistic regression analysis of the remaining 720 infants showed that the risk factors that were significantly associated with increased mortality before discharge were: delivery in district hospitals, Chinese race, lower birthweight, lower gestation age, persistent pulmonary hypertension of the newborn, pulmonary airleak, necrotizing enterocolitis of stage 2 or 3, confirmed sepsis, hypotension, hypothermia, acute renal failure, intermittent positive pressure ventilation, and umbilical arterial catheterization. Factors that were significantly associated with lower risk of mortality were: use of antenatal steroid, oxygen therapy, surfactant therapy and blood transfusion.

Conclusion:

The mortality of VLBW infants admitted to the Malaysian NICU was high and was also associated with a number of preventable risk factors.     

Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants

OBJECTIVE: To compare the effects of continuous versus intermittent feeding on gastrointestinal tolerance and growth in very low birth weight (VLBW) infants. STUDY DESIGN: In a randomized, controlled trial conducted at 3 neonatal units, 70 premature infants with a gestational age 24 to 29 weeks and birth weight < 1200 g were assigned to 1 of 3 feeding methods: continuous nasogastric feeding, intermittent nasogastric feeding, or intermittent orogastric feeding. Feeding was initiated within 30 hours of birth. Daily enteral and parenteral volumes, caloric and protein intakes, growth, enteral intolerance, and clinical complications were recorded. Cox regression analysis was used to determine primary outcome, the time to achieve full enteral feeding. RESULTS: The continuously fed infants achieved full enteral feeding significantly faster than the intermittently fed infants (hazard ratio [HR] = 1.86; 95% confidence interval [CI] = 1.07 to 3.22). In stratified analysis according to birth weight, the improvement was even more pronounced in the smallest infants, those with birth weight < or = 850 g (adjusted HR = 4.13; 95% CI = 1.48 to 11.53). Growth rate was significantly faster in the continuously fed infants ( P = .002). CONCLUSION: In VLBW infants, continuous feeding seems to be better than intermittent feeding with regard to gastrointestinal tolerance and growth.     

Minimal enteral feeding reduces the risk of sepsis in feed-intolerant very low birth weight newborns

Aims: To evaluate the efficacy and safety of minimal enteral feeding (MEF) nutritional practice in feed-intolerant very low birth weight (VLBW) infants.
Methods: A retrospective design using data reported in the clinical charts of VLBW newborns consecutively observed in neonatal intensive care units (NICU) that presents feed intolerance. During the study period, two feeding strategies were adopted: total parenteral nutrition (PN) (group 1) or PN plus MEF (group 2), for at least 24 h. Primary outcome was the time to reach full enteral feeding; secondary outcomes were the occurrence of sepsis, the time to regain birth weight, the length of hospitalization, the occurrence of necrotizing enterocolitis (NEC) Bell stage >II and death.
Results: In total, 102 newborns were evaluated: 51 in group 1, and 51 in group 2. Neonates in group 2 achieved full enteral nutrition earlier (8 days, interquartile range [IQR] 5) compared with subjects receiving total PN (11 days, IQR 5, p < 0.001). A reduction of sepsis episodes was observed in group 2 (15.7%) compared with group 1 (33.3%, p = 0.038). Additionally, subjects in group 2 regained their birth weight and were discharged earlier. The occurrence of NEC and death were similar in the two groups.
Conclusion: Minimal enteral feeding in very low birth weight infants presenting feed intolerance reduces the time to reach full enteral feeding and the risk of sepsis. This feeding practice does not increase the risk of necrotizing enterocolitis and death.     

Retrolental fibroplasia--controlled study of 4 years' experience in a neonatal intensive care unit.

During the 4 years 1977-80, 14 infants developed retrolental fibroplasia (RLF) in the neonatal unit at this medical centre. All were very low birthweight (VLBW) infants who weighed 1500 g or less at birth. The incidence of RLF was 3.5% for all VLBW infants admitted for neonatal intensive care and 4.7% for VLBW survivors. The mean birthweight of the affected infants was 970 (range 730-1310) g and mean gestational age 26 (range 24-29) weeks. Seven of the affected infants (2.4% of VLBW survivors) had significant scarring with temporal dragging of the optic disc and retinal detachment. Each of the 14 infants was matched with 2 control infants in order to see whether any factors predisposing to the development of RLF, including those related to oxygen therapy and monitoring, could be identified. The only factor associated with RLF was a higher volume of blood given with replacement transfusions. The occurrence of RLF was unrelated to an increase in requirement for or duration of oxygen therapy, arterial oxygen tensions as determined by intermittent sampling, or the availability of transcutaneous oxygen monitoring. The care taken in oxygen therapy may have been responsible for failure to show a quantitative association between hyperoxaemia and RLF. Although the problem of oxygen therapy in preterm infants is far from being resolved, current neonatal intensive care methods have limited the occurrence of RLF to VLBW infants. This study demonstrated a lower incidence of RLF in VLBW infants despite an improved survival rate compared with that previously reported.     

A placebo-controlled trial of low-dose erythromycin to promote feed tolerance in preterm infants

The aim of this study was to assess the efficacy of erythromycin, a motilin agonist, in promoting enteral feed tolerance in preterm infants of < or = 32 wk gestation. Eligible infants were randomized to receive either low-dose (2.5 mg kg(-1) per dose 6 hourly) oral erythromycin ethylsuccinate or placebo for 10 d from the time of the first oral feed. The data from 22 erythromycin and 21 placebo infants were analysed. Birthweights (erythromycin 1,216 +/- 380 g, placebo 1,355 +/- 228 g, p = 0.25), gestation (erythromycin 28.6 +/- 2.2 wk, placebo 29.3 +/- 1.7 wk, p = 0.24) and other clinical variables were not different between the groups. Almost all infants were fed expressed breast milk. Erythromycin infants had significantly fewer episodes of large residual gastric aspirates (>30% of the previous 6 h worth of feeds) over 10 d (erythromycin 1.1 +/- 1.9, placebo 3.6 +/- 2.2 episodes, p = 0.0007). Infants in the erythromycin group achieved full oral feeds more quickly (6.0 +/- 2.3 vs 7.9 +/- 3.5 d, p = 0.04). There were no significant differences between the groups with regard to the number of days on total parenteral nutrition or to the time needed to regain birthweight. One enrolled infant from each group died of necrotizing enterocolitis. CONCLUSION: Low-dose erythromycin promoted gastric emptying and feed tolerance in premature infants at a lower gestational age than previously reported. Increased exposure to broad-spectrum antibiotics may not be free of risk. Further studies are recommended to assess its efficacy in premature infants with established feed intolerance.     

Calorie intake in sick versus respiratory stable very low birthweight babies

A comparison between the calorie intake and energy source of sick versus respiratory stable very low birthweight (VLBW, less than 1500 g) babies was made to ascertain the time taken for them to achieve adequate daily calorie intake. It was an observational study of 23 consecutive VLBW babies in which sick respiratory unstable babies were defined as those who required ventilation beyond 72 h of life. Data were collected on the daily fluid and calorie intake for 30 days of life, and beyond if necessary until the babies achieved full enteral feeding and calorie intake of more than 100 kcal/kg per day. Growth parameters at the time of transfer or discharge were also analyzed. In the study, there were 14 sick VLBW and 9 respiratory stable babies with a mean birthweight of 1027 g and 1212 g, respectively. Their mean gestational age (28.7 weeks vs 31.2 weeks), mean age when calorie intake of 100 kcal/kg per day was achieved (19.8 days vs 7.0 days), mean duration of parenteral nutrition (17.1 days vs 2.7 days), mean age when enteral feeds commenced (8.9 days vs 1.7 days) and mean age when full enteral feeding was established (20.6 days vs 7.3 days) were statistically different for the two groups. For the respiratory unstable babies, parenteral nutrition provided more energy than milk until 15 days of life. The average daily energy intake of 100 kcal/kg per day was only achieved by 30 days of life in this group. In the respiratory stable group, milk provided more than 100 kcal/kg per day from 10 days of life. There were no significant differences in somatic growth with regard to bodyweight, length and head circumference for these two groups of babies at the time of transfer or discharge. The daily calorie intake of sick VLBW babies was suboptimal even with the use of parenteral nutrition. The respiratory stable babies, through enteral feeding, easily achieved the recommended daily calorie intake.     

Neuropsychiatric disorders in newborn infants with very low birth weight (VLBW infants)--before and following introduction of modern perinatal medicine. 1. Overview of the problem, criteria for quality of survival, major CNS disorders (major handicap)

The survival quality of very low birthweight infants (VLBW infants) is highly actual just even in the time of modern perinatal medicine. Through the development and permanent improvement of the perinatal intensive therapy the survival chances of VLBW infants could be improved significantly in the last 25 years. In the 70's survival rates of 60-84 per cent were achieved in VLBW infants, in the leading centers even rates of 86 and 90.5 percent, respectively. In the 70's an enormous improvement in the survival rates from 20-45 per cent was achieved in tiny premature infants (birth weight 1,000 gm and less), too. However, the efforts of gynecologists and neonatologists to reduce the mortality of low birth-weight infants are again and again blamed for possibly obtaining successes with an increase in CNS morbidity. The parallel analysis of some brain damage groups in VLBW infants seems suitable to gain a clear statement if modern perinatal medicine contributes to reduce the frequency of early infantile cerebral damages and their consecutive handicaps altogether. In an extensive review of literature it is tried to prove this for the major CNS handicaps altogether and separately for the infantile cerebral palsies, epilepsies and mental retardations (oligophrenias). Simultaneously with an average increase from 29.7 to 69.5 per cent of the healthy surviving children, there was a reduction of major CNS handicaps on the average from 36 to 12 per cent.     

A randomized controlled trial of enteral glutamine supplementation in very low birth weight infants: plasma amino acid concentrations

OBJECTIVE: Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression. Very low birth weight (VLBW) infants are susceptible to glutamine depletion, as enteral nutrition is limited in the first weeks of life. Enteral glutamine supplementation may have a positive effect on feeding tolerance, infectious morbidity and short-term outcome. The aim of the study was to determine the effect of enteral glutamine supplementation on plasma amino acid concentrations, reflecting one aspect of safety of enteral glutamine supplementation in VLBW infants. METHODS: In a double-blind placebo-controlled randomized controlled trial, VLBW infants (gestational age <32 weeks or birth weight <1500 g) received enteral glutamine supplementation (0.3 g/kg per day) or isonitrogenous placebo supplementation (alanine) between day 3 and day 30 of life. Supplementation was added to breast milk or to preterm formula. Plasma amino acid concentrations were measured at four time points: before the start of the study and at days 7, 14 and 30 of life. RESULTS: Baseline patient and nutritional characteristics were not different in glutamine (n = 52) and control (n = 50) groups. Plasma concentrations of most essential and non-essential amino acids increased throughout the study period. There was no effect of enteral glutamine supplementation. In particular, the increase of plasma glutamine and glutamate concentrations was not different between the treatment groups (P = 0.49 and P = 0.34 respectively, day 30). CONCLUSIONS: Enteral glutamine supplementation in VLBW infants does not alter plasma concentrations of glutamine, glutamate or other amino acids. Enteral supplementation in a dose of 0.3 g/kg per day seems safe in VLBW infants.     

A study of feeding patterns in young infants

With the aim of studying the feeding patterns in infants under 6 months of age, 451 mothers attending the children's clinic in two university hospitals in the north of Tehran were interviewed. All babies had been born in hospital and > 98 per cent had been breastfed during the first few hours of birth. The rate of full breastfeeding at 6 months of age, with no introduction of the bottle, was 83 per cent; approximately 6.5 per cent of infants were fed on breast and bottle concomitantly, and in about 10.5 per cent breastfeeding had been discontinued before 6 months and the babies were fed on bottle only. About 60 per cent of mothers who stopped breastfeeding, did so during the first postnatal month and another 20 per cent during the 2nd and 3rd month after the babies' birth. The mother's age, education or parity, did not affect the rate of breastfeeding. Low birthweight, especially birthweight less than 2 kg, was a risk factor for early termination of breastfeeding. Caesarean delivery and hospitalization of the infant during the neonatal period was also associated with a higher rate of bottlefeeding compared with newborns who had been delivered normally, discharged early, and nursed at home. Although breastfeeding rates are high, the finding that the majority of mothers who give up breastfeeding do so in the early weeks, calls for better support to all mothers by committed health personnel during the period when breastfeeding is being established, and for extra assistance to women whose infants are hospitalized or have a low birthweight.     

Early enteral feeding and nosocomial sepsis in very low birthweight infants

BACKGROUND: The interrelations between early enteral feeding, necrotising enterocolitis (NEC), and nosocomial sepsis (NS) remain unclear. OBJECTIVE: To evaluate the effect of age at the introduction of enteral feeding on the incidence of NS and NEC in very low birthweight (VLBW< 1500 g) infants. METHODS: Data were collected on the pattern of enteral feeding and perinatal and neonatal morbidity on all VLBW infants born in one centre during 1995-2001. Enteral feeding was compared between infants with and without NS and/or NEC. RESULTS: The study sample included 385 infants. Of these, 163 (42%) developed NS and 35 (9%) developed NEC. Enteral feeding was started at a significantly earlier mean (SD) age in infants who did not develop nosocomial sepsis (2.8 (2.6) v 4.8 (3.7) days, p = 0.0001). Enteral feeding was introduced at the same age in babies who did or did not develop NEC (3.1 (2) v 3.7 (3) days, p = 0.28). Over the study period, the mean annual age at the start of enteral feeding fell consistently, and this correlated with the mean annual incidence of NS (r(2) = 0.891, p = 0.007). Multiple logistic regression analysis showed age at start of enteral feeding, respiratory distress syndrome, and birth weight to be the most significant predictors of risk of NS (p = 0.0005, p = 0.024, p = 0.011). CONCLUSIONS: Early enteral feeding was associated with a reduced risk of NS but no change in the risk of NEC in VLBW infants. These findings support the use of early enteral feeding in this high risk population, but this needs to be confirmed in a large randomised controlled trial.     

Availability of donor milk improves enteral feeding but has limited effect on body growth of infants with very‐low birthweight: Data from a historic cohort study

Compare with preterm formula, donor human milk (DM) is associated with a lower risk of mortality and morbidity in preterm infants. It is thus deemed superior to preterm formula as the sole diet or supplement to own mother''s milk (OMM) for preterm infants, especially for those with very low birthweight (VLBW). This historic cohort study investigated the relationship between DM availability, and enteral feeding, body growth of VLBW infants by comparing two cohorts before and after the establishment of a human milk bank. A sub‐analysis was also conducted between small‐for‐gestational‐age (SGA) and non‐SGA infants in our cohorts. Our results showed that DM availability was associated with earlier initiation and faster advancement of enteral feeding, earlier attainment of full enteral feeding, and a higher proportion of OMM in enteral feeding. DM availability was also associated with earlier regain of birthweight, but not with better body growth. SGA and non‐SGA infants responded differently to DM availability with only the non‐SGA group showing improved enteral feeding associated with DM availability. The poor growth of VLBW infants with fortified DM warrants further investigations on better fortification strategies to further improve body growth. Studies are also needed on long‐term effects of DM feeding on the development of VLBW infants.     

Growth in VLBW infants fed predominantly fortified maternal and donor human milk diets: a retrospective cohort study

ABSTRACT: BACKGROUND: To determine the effect of human milk, maternal and donor, on in-hospital growth of very low birthweight (VLBW) infants. We performed a prospective cohort study comparing in-hospital growth in VLBW infants by proportion of human milk diet, including subgroup analysis by maternal or donor milk type. Primary outcome was change in weight z-score from birth to hospital discharge. RESULTS: 171 infants with median gestational age 27 weeks (IQR 25.4, 28.9) and median birthweight 899 g (IQR 724, 1064) were included. 97% of infants received human milk, 51% received > 75% of all enteral intake as human milk. 16% of infants were small-for-gestational age (SGA, < 10th percentile) at birth, and 34% of infants were SGA at discharge. Infants fed >75% human milk had a greater negative change in weight z-score from birth to discharge compared to infants receiving < 75% (-0.6 vs, -0.4, p = 0.03). Protein and caloric supplementation beyond standard human milk fortifier was related to human milk intake (p = 0.04). Among infants receiving > 75% human milk, there was no significant difference in change in weight z-score by milk type (donor -0.84, maternal -0.56, mixed -0.45, p = 0.54). Infants receiving >75% donor milk had higher rates of SGA status at discharge than those fed maternal or mixed milk (56% vs. 35% (maternal), 21% (mixed), p = 0.08). CONCLUSIONS: VLBW infants can grow appropriately when fed predominantly fortified human milk. However, VLBW infants fed >75% human milk are at greater risk of poor growth than those fed less human milk. This risk may be highest in those fed predominantly donor human milk.     

Oral D‐penicillamine for the prevention of retinopathy of prematurity in very low birth weight infants: a randomized,placebo‐controlled trial

Purpose: To compare prophylactic enteral D‐penicillamine (DPA) with placebo for prevention of ‘retinopathy of prematurity (ROP) or death’ among very low birth weight (VLBW) infants. Methods: This was a double‐blind, single‐centre, randomized, placebo‐controlled trial with stratification (for birth weight <1250 and ≥1250 g) and blocking. Inborn neonates with birth weight 750–1500 g, gestation ≤32 weeks, age ≤5 days, who tolerated feeds were eligible. Neonates with gastro‐intestinal malformations, life‐threatening malformations and necrotizing enterocolitis were excluded. Enrolled subjects were randomly allocated to receive oral DPA suspension at 100 mg/kg/dose 8 h for 3 days, followed by 50 mg/kg/day for another 11 days or placebo. The primary outcome was ‘any ROP or death’. Secondary outcomes included any ROP, treatable ROP, adverse effects and feed intolerance. Results: A total of 88 subjects were enrolled. Baseline characteristics were similar with the exception of multiple gestation. There were no significant differences in primary and secondary outcomes, even after adjusting for multiple gestation and on sub‐group analysis. No adverse reaction was noted. Conclusion: Prophylactic enterally administered DPA suspension in a dose 100 mg/kg/dose 8 h for 3 days, followed by 50 mg/kg once per day for next 11 days, does not prevent ‘any stage ROP or death’ or ‘ROP requiring treatment’ in VLBW infants. DPA is well tolerated and does not have any major short‐term adverse effects.